title: Latent class analysis of co-morbidity in the Adult Psychiatric Morbidity Survey in England 2007: implications for DSM-5 and ICD-11.
abstract: BACKGROUND
  Psychiatric co-morbidity is complex and ubiquitous. Our aim was to describe the extent, nature and patterning of psychiatric co-morbidity within a representative sample of the adult population of England, using latent class analysis.
  
  
  METHODS
  Data were used from the 2007 Adult Psychiatric Morbidity Survey, a two-phase national household survey undertaken in 2007 comprising 7325 participants aged 16 years and older living in private households in England. The presence of 15 common mental health and behavioural problems was ascertained using standardized clinical and validated self-report measures, including three anxiety disorders, depressive episode, mixed anxiety depressive disorder, psychosis, antisocial and borderline personality disorders, eating disorders, post-traumatic stress disorder, attention deficit disorder, alcohol and drug dependencies, problem gambling and attempted suicide.
  
  
  RESULTS
  A four-class model provided the most parsimonious and informative explanation of the data. Most participants (81.6%) were assigned to a non-symptomatic or 'Unaffected' class. The remainder were classified into three qualitatively different symptomatic classes: 'Co-thymia' (12.4%), 'Highly Co-morbid' (5.0%) and 'Addictions' (1.0%). Classes differed in mean numbers of conditions and impairments in social functioning, and these dimensions were correlated.
  
  
  CONCLUSIONS
  Our findings confirm that mental disorders typically co-occur and are concentrated in a relatively small number of individuals. Conditions associated with the highest levels of disability, mortality and cost--psychosis, suicidality and personality disorders--are often co-morbid with more common conditions. This needs to be recognized when planning services and when considering aetiology.
authors.affiliation: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK. S.Weich@warwick.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Weich
authors.forename: O
authors.initials: O
authors.lastname: McBride
authors.forename: D
authors.initials: D
authors.lastname: Hussey
authors.forename: D
authors.initials: D
authors.lastname: Exeter
authors.forename: T
authors.initials: T
authors.lastname: Brugha
authors.forename: S
authors.initials: S
authors.lastname: McManus
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004739:England / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D016013:Likelihood Functions; D008297:Male; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D017678:Sex Distribution; D055815:Young Adult